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Nishizaki D, Eskander RN. Targeted Therapies, Biologics, and Immunotherapy in the Neoadjuvant and Adjuvant Settings: Perioperative Risks. Surg Oncol Clin N Am 2024; 33:279-291. [PMID: 38401910 DOI: 10.1016/j.soc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2024]
Abstract
Cancer therapeutics has been revolutionized by the introduction of molecularly targeted therapies and immune checkpoint inhibitors (ICIs). The paradigm of neoadjuvant therapy is commonly employed across multiple solid tumors, exhibiting significant clinical benefit as exemplified with ICIs in melanoma and non-small-cell lung cancer. However, neoadjuvant therapy can be associated with treatment-related adverse events. As the incorporation of these novel therapies in the preoperative space expands, it is crucial for surgical oncologists to understand the potential perioperative implications of these treatments. This article focuses on surgical considerations tied to these treatments, highlighting potential drug-surgery interactions and complications.
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Affiliation(s)
- Daisuke Nishizaki
- Division of Hematology and Oncology, Department of Medicine, Center for Personalized Cancer Therapy, University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Ramez N Eskander
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, Center for Personalized Cancer Therapy, University of California San Diego, Moores Cancer Center, La Jolla, CA, USA
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da Silva Machado FL, Cañás M, Urtasun MA, Marín GH, Albuquerque FC, Pont L, Convertino I, Bonaso M, Tuccori M, Kirchmayer U, Lopes LC. A Cross-National Comparison of Biosimilars Pricing in Argentina, Australia, Brazil, and Italy. Ther Innov Regul Sci 2024:10.1007/s43441-024-00623-8. [PMID: 38436905 DOI: 10.1007/s43441-024-00623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Biosimilar medicines are defined as biological products highly similar to an already licensed biological product (RP). The market entry of biosimilars is expected to reduce the costs of biological treatments. OBJECTIVE This study aims to evaluate the range of differences between the prices of biosimilars and the corresponding RP for biologicals approved in four countries. METHOD This is a cross-national comparison of pricing of biosimilars in Argentina, Australia, Brazil, and Italy. The study examined online price databases provided by the national authorities of the investigated countries. Biosimilar price difference was calculated by subtracting the unit price of the biosimilar by the unit price of the RP, and then dividing it by the unit price of the RP. The results were presented as percentage. RESULTS Brazil had the highest median price reduction (- 36.3%) in biosimilars price, followed by Italy (- 20.0%) and Argentina (- 18.6%). All the biosimilars in Italy were priced below the RP presenting a minimum reduction of 6.3%, while in Australia, most of the prices of biosimilars were equal to the RP. In Argentina, one infliximab-biosimilar displayed price above the RP (40.7%) while the lower priced brand had a reduction of 14.4%. Brazil had four biosimilars with prices above the respective RP, including isophane insulin (1), insulin glargine (1) and somatropin (2). CONCLUSION The study revealed a marked dispersion in the price's differences between biosimilars and RP across the studied countries. Governments should evaluate whether their policies have been successful in improving affordability of biological therapies.
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Affiliation(s)
- Fernanda Lacerda da Silva Machado
- Instituto de Ciências Farmacêuticas, Universidade Federal Do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil
- Sorocaba University, Sorocaba, São Paulo, Brazil
| | - Martín Cañás
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Martín A Urtasun
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Gustavo H Marín
- Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | | | - Lisa Pont
- University of Technology Sydney, Sydney, Australia
| | - Irma Convertino
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Bonaso
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marco Tuccori
- Unit of Pharmacology and Pharmacovigilance, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
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Romiti R, Hirayama ALDS, Porro AM, Gonçalves HDS, Miot LDB, Durães SMB, Marques SA. Infections in the era of immunobiologicals. An Bras Dermatol 2024; 99:167-180. [PMID: 38238209 PMCID: PMC10943328 DOI: 10.1016/j.abd.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/15/2023] [Accepted: 08/27/2023] [Indexed: 03/11/2024] Open
Abstract
Immunobiologicals represent an innovative therapeutic option in dermatology. They are indicated in severe and refractory cases of different diseases when there is contraindication, intolerance, or failure of conventional systemic therapy and in cases with significant impairment of patient quality of life. The main immunobiologicals used in dermatology basically include inhibitors of tumor necrosis factor-alpha (anti-TNF), inhibitors of interleukin-12 and -23 (anti-IL12/23), inhibitors of interleukin-17 and its receptor (anti-IL17), inhibitors of interleukin-23 (anti-IL23), rituximab (anti-CD20 antibody), dupilumab (anti-IL4/IL13) and intravenous immunoglobulin. Their immunomodulatory action may be associated with an increase in the risk of infections in the short and long term, and each case must be assessed individually, according to the risk inherent to the drug, the patient general condition, and the need for precautions. This article will discuss the main risks of infection associated with the use of immunobiologicals, addressing the risk in immunocompetent and immunosuppressed patients, vaccination, fungal infections, tuberculosis, leprosy, and viral hepatitis, and how to manage the patient in the most diverse scenarios.
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Affiliation(s)
- Ricardo Romiti
- Department of Dermatology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Adriana Maria Porro
- Department of Dermatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Heitor de Sá Gonçalves
- State Health Secretariat of Ceará, Centro de Dermatologia Dona Libânia, Fortaleza, CE, Brazil
| | - Luciane Donida Bartoli Miot
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
| | - Sandra Maria Barbosa Durães
- Department of Internal Medicine, Dermatology Unit, Faculty of Medicine, Universidade Federal Fluminense, Niterói, RJ, Brazil
| | - Silvio Alencar Marques
- Department of Infectology, Dermatology, Imaging Diagnosis and Radiotherapy, Faculty of Medicine, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Kim MG, Kim S, Jeon JY, Moon SJ, Kwak YG, Na JY, Lee S, Park KM, Kim HJ, Lee SM, Choi SY, Shin KH. Profiling of endogenous metabolites and changes in intestinal microbiota distribution after GEN-001 ( Lactococcus lactis) administration. Korean J Physiol Pharmacol 2024; 28:153-164. [PMID: 38414398 PMCID: PMC10902589 DOI: 10.4196/kjpp.2024.28.2.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/18/2023] [Accepted: 12/22/2023] [Indexed: 02/29/2024]
Abstract
This study aimed to identify metabolic biomarkers and investigate changes in intestinal microbiota in the feces of healthy participants following administration of Lactococcus lactis GEN-001. GEN-001 is a single-strain L. lactis strain isolated from the gut of a healthy human volunteer. The study was conducted as a parallel, randomized, phase 1, open design trial. Twenty healthy Korean males were divided into five groups according to the GEN-001 dosage and dietary control. Groups A, B, C, and D1 received 1, 3, 6, and 9 GEN-001 capsules (1 × 1011 colony forming units), respectively, without dietary adjustment, whereas group D2 received 9 GEN-001 capsules with dietary adjustment. All groups received a single dose. Fecal samples were collected 2 days before GEN-001 administration to 7 days after for untargeted metabolomics and gut microbial metagenomic analyses; blood samples were collected simultaneously for immunogenicity analysis. Levels of phenylalanine, tyrosine, cholic acid, deoxycholic acid, and tryptophan were significantly increased at 5-6 days after GEN-001 administration when compared with predose levels. Compared with predose, the relative abundance (%) of Parabacteroides and Alistipes significantly decreased, whereas that of Lactobacillus and Lactococcus increased; Lactobacillus and tryptophan levels were negatively correlated. A single administration of GEN-001 shifted the gut microbiota in healthy volunteers to a more balanced state as evidenced by an increased abundance of beneficial bacteria, including Lactobacillus, and higher levels of the metabolites that have immunogenic properties.
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Affiliation(s)
- Min-Gul Kim
- Center for Clinical Pharmacology, Jeonbuk National University Hospital, Jeonju 54907, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
- Department of Pharmacology, School of Medicine, Jeonbuk National University, Jeonju 54907, Korea
| | - Suin Kim
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Korea
| | - Ji-Young Jeon
- Center for Clinical Pharmacology, Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Seol Ju Moon
- Center for Clinical Pharmacology, Jeonbuk National University Hospital, Jeonju 54907, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 54907, Korea
| | - Yong-Geun Kwak
- Center for Clinical Pharmacology, Jeonbuk National University Hospital, Jeonju 54907, Korea
- Department of Pharmacology, School of Medicine, Jeonbuk National University, Jeonju 54907, Korea
| | - Joo Young Na
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | - SeungHwan Lee
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul 03080, Korea
| | | | | | - Sang-Min Lee
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Korea
| | - Seo-Yeon Choi
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Korea
| | - Kwang-Hee Shin
- College of Pharmacy, Research Institute of Pharmaceutical Sciences, Kyungpook National University, Daegu 41566, Korea
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Kim JH, Samra MS. Moderate to severe atopic dermatitis in children: focus on systemic Th2 cytokine receptor antagonists and Janus kinase inhibitors. Clin Exp Pediatr 2024; 67:64-79. [PMID: 37321570 PMCID: PMC10839191 DOI: 10.3345/cep.2022.00346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 12/26/2022] [Accepted: 01/13/2023] [Indexed: 06/17/2023] Open
Abstract
Atopic dermatitis (AD) is a lifelong disease that markedly impairs quality of life. AD is considered a starting point of the "atopic march," which begins at a young age and may progress to systemic allergic diseases. Moreover, it is strongly associated with comorbid allergic and inflammatory diseases including arthritis and inflammatory bowel disease. Understanding the pathogenesis of AD is essential for the development of targeted therapies. Epidermal barrier dysfunction, immune deviation toward a T helper 2 proinflammatory profile, and microbiome dysbiosis play important roles via complex interactions. The systemic involvement of type 2 inflammation, wheather acute or chronic, and whether extrinsic or intrinsic, is evident in any type of AD. Studies on AD endotypes with unique biological mechanisms have been conducted according to clinical phenotypes, such as race or age, but the endotype for each phenotype, or endophenotype, has not yet been clearly identified. Therefore, AD is still being treated according to severity rather than endotype. Infancy-onset and severe AD are known risk factors leading to atopic march. In addition, up to 40% of adult AD are cases of infancy-onset AD that persist into adulthood, and these are often accompanied by other allergic diseases. Therefore, early intervention strategies to identify high-risk infants and young children, repair an impaired skin barrier, and control systemic inflamation may improve long-term outcomes in AD patients. However, to the best of our knowledge, no study has evaluated the effectiveness of early intervention on atopic march using systemic therapy in high-risk infants. This narrative review addresses the latest knowledge of systemic treatment, including Th2 cytokine receptor antagonists and Janus kinase inhibitors, for children with moderate to severe AD that is refractory to topical treatment.
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Affiliation(s)
- Jeong Hee Kim
- Department of Pediatrics, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
| | - Mona Salem Samra
- Department of Pediatrics, Inha University Hospital, College of Medicine, Inha University, Incheon, Korea
- Staffordshire Children's Hospital, University Hospitals of North Midlands, Staffordshire, UK
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Poddar A, Raggio M, Concato J. Decisions on Non-oncology Breakthrough Therapy Designation Requests in 2017-2019. Ther Innov Regul Sci 2024; 58:214-221. [PMID: 37926768 PMCID: PMC10764372 DOI: 10.1007/s43441-023-00589-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND The US Food and Drug Administration's Breakthrough Therapy Designation (BTD) program is intended to facilitate and expedite development of investigational drugs to address unmet medical needs. The objective of this study is to provide an update on FDA's process for review of BTD requests. METHODS We reviewed Center for Drug Evaluation and Research (CDER) decisions to grant or deny breakthrough therapy designation requests for non-oncology drugs or biological products ("drugs") from January 1, 2017, through December 31, 2019. Data collection included characteristics of the corresponding drug and condition, reasons for granting or denying breakthrough therapy status, reasons for rescinding or withdrawing breakthrough therapy status after a request was granted (if applicable), and subsequent marketing approval status through 2022. RESULTS Among 240 requests, 93 (39%) requests were granted and 147 (61%) requests were denied. Granting of requests was more common for conditions where no therapy was available or for orphan diseases. Common reasons for denial included data-related issues, insufficient treatment effect, inadequate study design, endpoint attributes, safety issues, and reliance on post hoc analyses. Among 28 drugs receiving marketing approval as of the end of 2022 for the indication for which BTD was previously granted, 21 (75%) involved a first-in-class mechanism of action. CONCLUSIONS This analysis describes CDER's decision-making process related to review of requests for breakthrough therapy designations and enhances public awareness regarding efforts to expedite drug development.
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Affiliation(s)
- Atasi Poddar
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, WO51-6324, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA
| | - Miranda Raggio
- Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - John Concato
- Office of Medical Policy, Center for Drug Evaluation and Research, US Food and Drug Administration, WO51-6324, 10903 New Hampshire Avenue, Silver Spring, MD, 20993, USA.
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Maspero JF, Shafazand S, Cole J, Pavord ID, Busse WW, Msihid J, Gall R, Soler X, Radwan A, Khan AH, de Prado Gómez L, Jacob-Nara JA. Dupilumab efficacy in high sleep disturbance management among patients with type 2 asthma. Respir Med 2023; 218:107344. [PMID: 37659435 DOI: 10.1016/j.rmed.2023.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Patients with asthma often experience sleep disturbances. We assessed the 5-item Asthma Control Questionnaire (ACQ-5) score ≥2.5 as a useful threshold to identify patients with moderate-to-severe type 2 asthma and high sleep disturbance (HSD) and investigated dupilumab efficacy on clinical and sleep-related outcomes among patients with HSD. METHODS QUEST (NCT02414854) data were used in this post hoc analysis. A composite endpoint from validated patient-reported outcomes was developed to identify patients with HSD using sleep-related items from the ACQ-5, Asthma-Related Quality-of-Life Questionnaire, Rhino-Conjunctivitis Quality-of-Life Questionnaire, and Sino-Nasal Outcome Test-22. Impairment in at least 1 item was considered an indication of HSD. Change from baseline to Week 52 in nighttime symptoms, ACQ-5 score, lung function, annualized severe exacerbation rates (AER), and short-acting β-agonists use during treatment was used to assess dupilumab efficacy. RESULTS In type 2 asthma patients, 64% had HSD at baseline; of those with ACQ-5 ≥2.5 at baseline, 82% had HSD. In this population, dupilumab reduced nighttime symptoms and ACQ-5 score by 0.31 and 0.56 points, respectively, by Week 52 versus placebo, and led to a 66% reduction in AER during QUEST and 0.34 L improvement in pre-bronchodilator (pre-BD) forced expiratory volume in 1 s (FEV1) at Week 52. CONCLUSION A majority of patients with moderate-to-severe type 2 asthma with ACQ-5 ≥2.5 at baseline had HSD. Dupilumab reduced nighttime symptoms and exacerbations, and improved lung function, overall asthma control, and quality of life. Further studies are needed to confirm the association between ACQ-5 score ≥2.5 and higher sleep disturbance rates.
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Affiliation(s)
| | | | | | - Ian D Pavord
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Rebecca Gall
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Xavier Soler
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
| | - Amr Radwan
- Regeneron Pharmaceuticals Inc., Tarrytown, NY, USA
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Abstract
Ankylosing spondylitis (AS) is an autoinflammatory disease that manifests with the unique feature of enthesitis. Gut microbiota, HLA-B*27, and biomechanical stress mutually influence and interact resulting in setting off a flame of inflammation. In the HLA-B*27 positive group, dysbiosis in the gut environment disrupts the barrier to exogenous bacteria or viruses. Additionally, biomechanical stress induces inflammation through enthesial resident or gut-origin immune cells. On this basis, innate and adaptive immunity can propagate inflammation and lead to chronic disease. Finally, bone homeostasis is regulated by cytokines, by which the inflamed region is substituted into new bone. Agents that block cytokines are constantly being developed to provide diverse therapeutic options for preventing the progression of inflammation. In addition, some antibodies have been shown to distinguish disease selectively, which support the involvement of autoimmune immunity in AS. In this review, we critically analyze the complexity and uniqueness of the pathogenesis with updates on the findings of immunity and provide new information about biologics and biomarkers.
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Affiliation(s)
- Se Hee Kim
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang-Hoon Lee
- Division of Rheumatology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Espitia GJ, Arenas NE, Gutiérrez-Castañeda LD, Guerrero MI. Bioinformatic approach for repurposing immunomodulatory drugs for lepromatous leprosy. Int J Mycobacteriol 2023; 12:388-393. [PMID: 38149532 DOI: 10.4103/ijmy.ijmy_105_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background The lepromatous leprosy (LL) disease is caused by Mycobacterium leprae and Mycobacterium lepromatosis which is characterized by inadequate response to treatment, a propensity to drug resistance, and patient disability. We aimed to evaluate current immunomodulatory medicines and their target proteins collectively as a drug repurposing strategy to decipher novel uses for LL. Methods A dataset of human genes associated with LL-immune response was retrieved from public health genomic databases including the Human Genome Epidemiology Navigator and DisGeNET. Retrieved genes were filtered and enriched to set a robust network (≥10, up to 21 edges) and analyzed in the Cytoscape program (v3.9). Drug associations were obtained in the NDEx Integrated Query (v1.3.1) coupled with drug databases such as ChEMBL, BioGRID, and DrugBank. These networks were analyzed in Cytoscape with the CyNDEx-2 plugin and STRING protein network database. Results Pathways analyses resulted in 100 candidate drugs organized into pharmacological groups with similar targets and filtered on 54 different drugs. Gene-target network analysis showed that the main druggable targets associated with LL were tumoral necrosis factor-alpha, interleukin-1B, and interferon-gamma. Consistently, glucosamine, binimetinib, talmapimod, dilmapimod, andrographolide, and VX-702 might have a possible beneficial effect coupled with LL treatment. Conclusion Based on our drug repurposing analysis, immunomodulatory drugs might have a promising potential to be explored further as therapeutic options or to alleviate symptoms in LL patients.
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Affiliation(s)
- Gary J Espitia
- Group Basic Sciences in Health, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud-FUCS, Bogota, Colombia
| | - Nelson Enrique Arenas
- Group of Tropical Dermatology, Hospital Universitario Centro Dermatológico Federico Lleras Acosta; Department of Biology, Faculty of Sciences, Universidad Antonio NariñoBogota, Colombia, Bogota, Colombia
| | - Luz Dary Gutiérrez-Castañeda
- Group Basic Sciences in Health, Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud-FUCS; Group of General Dermatology, Centro Dermatológico Federico Lleras Acosta; Department of Basic Sciences, Group Basic Sciences in Health, University Children Hospital of San José, Bogota, Colombia
| | - Martha Inírida Guerrero
- Group of Tropical Dermatology, Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogota, Colombia
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Machado FLDS, Cañás M, Doubova SV, Urtasun MA, Marín GH, Osorio-de-Castro CGS, Albuquerque FC, Ribeiro TB, Pont L, Crisóstomo Landeros J, Roldán Saelzer J, Sepúlveda Viveros D, Acosta A, Machado Beltrán MA, Gordillo Alas LI, Orellana Tablas LA, Benko R, Convertino I, Bonaso M, Tuccori M, Kirchmayer U, Contreras Sánchez SE, Rodríguez-Tanta LY, Gutierrez Aures Y, Lin B, Alipour-Haris G, Eworuke E, Lopes LC. Biosimilars approvals by thirteen regulatory authorities: A cross-national comparison. Regul Toxicol Pharmacol 2023; 144:105485. [PMID: 37659711 DOI: 10.1016/j.yrtph.2023.105485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/04/2023]
Abstract
Biosimilars are biological medicines highly similar to a previously licensed reference product and their licensing is expected to improve access to biological therapies. This study aims to present an overview of biosimilars approval by thirteen regulatory authorities (RA). The study is a cross-national comparison of regulatory decisions involving biosimilars in Argentina, Australia, Brazil, Chile, Canada, Colombia, Europe, Hungary, Guatemala, Italy, Mexico, Peru and United States. We examined publicly available documents containing information regarding the approval of biosimilars and investigated the publication of public assessment reports for registration applications, guidelines for biosimilars licensing, and products approved. Data extraction was conducted by a network of researchers and regulatory experts. All the RA had issued guidance documents establishing the requirements for the licensing of biosimilars. However, only three RA had published public assessment reports for registration applications. In total, the investigated jurisdictions had from 19 to 78 biosimilars approved, most of them licensed from 2018 to 2020. In spite of the advance in the number of products in recent years, some challenges still persist. Limited access to information regarding the assessment of biosimilars by RA can affect confidence, which may ultimately impact adoption of these products in practice.
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Affiliation(s)
- Fernanda Lacerda da Silva Machado
- Instituto de Ciências Farmacêuticas, Universidade Federal do Rio de Janeiro, Macaé, Rio de Janeiro, Brazil; Sorocaba University, Sorocaba, São Paulo, Brazil
| | - Martín Cañás
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | - Martín A Urtasun
- Universidad Nacional Arturo Jauretche-FEMEBA, La Plata, Argentina
| | - Gustavo H Marín
- Universidad Nacional de La Plata-CONICET, La Plata, Argentina
| | | | | | - Tatiane Bonfim Ribeiro
- Post Graduate Program in Epidemiology, Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Lisa Pont
- University of Technology Sydney, Sydney, Australia
| | | | | | | | - Angela Acosta
- Facultad de Ciencias Naturales, Departamento de Ciencias Farmacéuticas, Universidad ICESI, Cali, Colombia
| | | | - Lily Iracema Gordillo Alas
- Department of Regulation and Control of Pharmaceutical and Related Products, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Lourdes Abigail Orellana Tablas
- Department of Regulation and Control of Pharmaceutical and Related Products, Ministry of Public Health and Social Assistance, Guatemala City, Guatemala
| | - Ria Benko
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | | | | | | | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Saúl E Contreras Sánchez
- Epidemiology and Health Services Research Unit, Mexican Institute of Social Security, Mexico City, Mexico
| | - L Yesenia Rodríguez-Tanta
- Carrera de Farmacia y Bioquímica, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
| | | | - Boya Lin
- University of Florida, United States
| | | | - Efe Eworuke
- Epidemiology and Drug Safety Team, Real World Solutions, IQVIA, United States
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Iwamoto H, Hirano T, Amano Y, Murakawa K, Fukatsu-Chikumoto A, Yamaji Y, Yamane M, Anabuki K, Otani T, Higaki N, Miyamoto S, Isobe T, Yokoyama A, Matsunaga K, Hattori N. Prospective Real-World Analysis of Asthma Patients With Preserved and Reduced Physical Activity. J Allergy Clin Immunol Pract 2023; 11:2792-2800.e2. [PMID: 37178763 DOI: 10.1016/j.jaip.2023.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Asthma is a highly heterogeneous airway disease, and the clinical characteristics of patients with asthma with preserved and reduced physical activity are poorly understood. OBJECTIVE We aimed to investigate the risk factors and clinical phenotypes associated with reduced physical activity in a wide range of patients with asthma. METHODS We conducted a prospective observational study of 138 patients with asthma, including patients with asthma without chronic obstructive pulmonary disease (COPD) (n = 104) and asthma-COPD overlap (n = 34), and 42 healthy controls. Physical activity levels were measured for 2 weeks using a triaxial accelerometer at baseline and 1 year later. RESULTS Higher eosinophils and body mass index (BMI) were associated with reduced physical activity in patients with asthma without COPD. Cluster analysis of asthma without COPD revealed 4 asthma phenotypes. We identified a cluster with preserved physical activity (n = 43) that was characterized by good symptom control and lung function and included a high proportion of biologics users (34.9%). Multivariate regression analysis revealed that patients with late-onset eosinophilic (n = 21), high-BMI noneosinophilic (n = 14), and symptom-predominant asthma phenotypes (n = 26) had lower levels of physical activity than controls. Patients with asthma-COPD overlap also had significantly lower physical activity levels than controls. Similar trends in physical activity levels were observed in each asthma group at 1-year follow-up. CONCLUSION This study showed the clinical features of patients with asthma with preserved and reduced physical activity. Reduced physical activity was observed in various asthma phenotypes and in asthma-COPD overlap.
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Affiliation(s)
- Hiroshi Iwamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Tsunahiko Hirano
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yoshihiro Amano
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Shimane, Japan
| | - Keita Murakawa
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Ayumi Fukatsu-Chikumoto
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Yoshikazu Yamaji
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Mayuka Yamane
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazuki Anabuki
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Toshihito Otani
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Naoko Higaki
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shintaro Miyamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takeshi Isobe
- Department of Internal Medicine, Division of Medical Oncology & Respiratory Medicine, Shimane University Faculty of Medicine, Shimane, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kazuto Matsunaga
- Department of Respiratory Medicine and Infectious Disease, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
| | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Patel V, Taylor K, Schlick J, Hertig J. A Comparison of Instructions for Use Documents and Manufacturer Produced Administration Videos for Biological Products. Ther Innov Regul Sci 2023; 57:646-652. [PMID: 37031279 DOI: 10.1007/s43441-023-00516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/21/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVES To compare Instructions for Use (IFU) and Manufacturer Produced Administration Videos (MPAV) for biological products to describe if they are highly similar or different. To identify differences between the two that may lead to medication errors and to point out possible solutions to optimize safety. METHODS We screened 139 biological products having both an IFU and a MPAV. Differences between the IFU and MPAV of each biological product were noted and categorized by importance and how likely it would cause harm to patients. Strategies were discussed based on differences observed. RESULTS Of the products screened, 51 had an IFU and a MPAV available for evaluation. They were primarily made to support the use of auto-injectors (n = 25) and pre-filled syringes (n = 19). Of this group, we found that 11 had no differences between the IFU and MPAV, while the other 40 had at least one or more identifiable differences. Differences were stratified into the following sub-categories from most to least prevalent: word choice differences, supplementary information, missing information, and unaligned directions. We looked at the distribution of differences per biological product and found an average of two differences per MPAV (IQR 1-3). CONCLUSION We suggest that when sponsors create or update MPAVs, to focus on aligning critical content between the respective IFU and MPAV. We believe that it is possible for MPAVs to potentially reduce medication errors as a non-text-based media form and that care should be taken to avoid substantial differences in critical content between the IFU and MPAV.
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Affiliation(s)
- Vraj Patel
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA.
- Regeneron Pharmaceuticals, Tarrytown, NY, USA.
| | | | | | - John Hertig
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA
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Gleeson PK, Morales KH, Hvisdas C, LaCava AF, Harhay MO, Rank MA, Apter AJ, Himes BE. Factors Associated With Asthma Biologic Prescribing and Primary Adherence Among Adults in a Large Health System. J Allergy Clin Immunol Pract 2023; 11:1834-1842.e4. [PMID: 36907354 PMCID: PMC10330036 DOI: 10.1016/j.jaip.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND The availability of asthma biologics may not benefit all patients equally. OBJECTIVE We sought to identify patient characteristics associated with asthma biologic prescribing, primary adherence, and effectiveness. METHODS A retrospective, observational cohort study of 9,147 adults with asthma who established care with a Penn Medicine asthma subspecialist was conducted using Electronic Health Record data from January 1, 2016, to October 18, 2021. Multivariable regression models were used to identify factors associated with (1) receipt of a new biologic prescription; (2) primary adherence, defined as receiving a dose in the year after receiving the prescription, and (3) oral corticosteroid (OCS) bursts in the year after the prescription. RESULTS Factors associated with a new prescription, which was received by 335 patients, included being a woman (odds ratio [OR] 0.66; P = .002), smoking currently (OR 0.50; P = .04), having an asthma hospitalization in the prior year (OR 2.91; P < .001), and having 4+ OCS bursts in the prior year (OR 3.01; P < .001). Reduced primary adherence was associated with Black race (incidence rate ratio 0.85; P < .001) and Medicaid insurance (incidence rate ratio 0.86; P < .001), although most in these groups, 77.6% and 74.3%, respectively, still received a dose. Nonadherence was associated with patient-level barriers in 72.2% of cases and health insurance denial in 22.2%. Having more OCS bursts after receiving a biologic prescription was associated with Medicaid insurance (OR 2.69; P = .047) and biologic days covered (OR 0.32 for 300-364 d vs 14-56 d; P = .03). CONCLUSIONS In a large health system, primary adherence to asthma biologics varied by race and insurance type, whereas nonadherence was primarily explained by patient-level barriers.
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Affiliation(s)
- Patrick K Gleeson
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa.
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Christopher Hvisdas
- The Ambulatory Care Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, Pa
| | - Anthony F LaCava
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Akron, Ohio
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Matthew A Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Ariz, and Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Ariz
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Blanca E Himes
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
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Lei Y, Yong Z, Junzhi W. Development and application of potency assays based on genetically modified cells for biological products. J Pharm Biomed Anal 2023; 230:115397. [PMID: 37079933 DOI: 10.1016/j.jpba.2023.115397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/04/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Abstract
Potency assays are key to the development, registration, and quality control of biological products. Although previously preferred for clinical relevance, in vivo bioassays have greatly diminished with the advent of dependent cell lines as well as due to ethical concerns. However, for some products, the development of in vitro cell-based assay is challenging, or existing method has limitations such as tedious procedure or low sensitivity. The generation of genetically modified (GM) cell line with improved response to the analyte provides a scientific and promising solution. Potency assays based on GM cell lines are currently used for the quality control of biological products including cytokines, hormones, therapeutic antibodies, vaccines and gene therapy products. In this review, we have discussed the general principles of designing and developing GM cells-based potency assays, including identification of cellular signaling pathways and detectable biological effects, generation of responsive cell lines and constitution of test systems, based on the current research progress. In addition, the applications of some novel technologies and the common concerns regarding GM cells have also been discussed. The research presented in this review provides insights for the development and application of novel GM cells-based potency assays for biological products.
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Affiliation(s)
- Yu Lei
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes for Food and Drug Control, No. 2, Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Zhou Yong
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes for Food and Drug Control, No. 2, Tiantan Xili, Dongcheng District, Beijing 100050, China
| | - Wang Junzhi
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products, National Institutes for Food and Drug Control, No. 2, Tiantan Xili, Dongcheng District, Beijing 100050, China.
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Choi EJ, Baek DH, Lee HS, Song GA, Kim TO, Park YE, Lee CM, Lee JH. The effect of biological agent on body composition in patients with Crohn's disease. BMC Gastroenterol 2023; 23:100. [PMID: 36997863 PMCID: PMC10064761 DOI: 10.1186/s12876-023-02742-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 03/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Crohn's disease (CD) is associated with altered body composition, affecting clinical outcomes. We evaluated the impact of biologics on body composition in CD patients. METHODS This multicenter longitudinal study across four Korean university hospitals conducted from January 2009 to August 2021 retrospectively reviewed data of CD patients with abdominal computed tomography (CT) before and after the biologic treatment. Skeletal muscle area (SMA), visceral fat area (VFA), and subcutaneous fat area (SFA) of the third lumbar vertebra (L3) on CT were measured. Myopenia was defined as L3 skeletal muscle index (SMI) of < 49 and < 31 cm2/m2 for men and women, respectively. RESULTS Among 112 participants, 79 (70.5%) had myopenia. In the myopenia group, all body composition parameters were significantly increased after the biologic treatment: SMI (37.68 vs. 39.40 cm2/m2; P < 0.001), VFA (26.12 vs. 54.61 cm2; P < 0.001), SFA (44.29 vs. 82.42 cm2; P < 0.001), while no significant differences were observed in the non-myopenia group. In multivariate analysis, penetrating CD (hazard ratio, 5.40; P = 0.020) was the independent prognostic factor for surgery. Operation-free survival rate tended to decrease in the myopenia group (Log-rank test, P = 0.090). CONCLUSIONS Biological agents can increase all body composition parameters in CD patients with myopenia. These patients are more likely to experience surgery.
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Affiliation(s)
- Eun Jeong Choi
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-Ro, Busanjin-Gu, Busan, 47392, Korea
| | - Dong Hoon Baek
- Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, 75 Bokji-Ro, Busanjin-Gu, Busan, 47392, Korea.
| | - Geun Am Song
- Department of Internal Medicine, Pusan National University College of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Tae Oh Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yong Eun Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Chang Min Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
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Burlando M, Herzum A, Cozzani E, Parodi A. Psoriasis flares after COVID-19 vaccination: adherence to biologic therapy reduces psoriasis exacerbations: a case-control study. Clin Exp Vaccine Res 2023; 12:80-81. [PMID: 36844681 PMCID: PMC9950225 DOI: 10.7774/cevr.2023.12.1.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/22/2022] [Indexed: 02/19/2023] Open
Abstract
This study aimed to evaluate if patients under biologics have a lower risk of psoriasis flares after coronavirus disease 2019 (COVID-19) vaccination than other psoriatic patients. Of 322 recently vaccinated patients admitted for psoriasis at the Dermatological Psoriasis Unit during January and February 2022, 316 (98%) had no psoriasis flares after COVID-19 vaccination (79% under biologic treatment, 21% not biologically treated) and 6 (2%) presented psoriasis flares after COVID-19 vaccination (33.3% under biologic treatment, 66.6% not biologically treated). Overall, psoriasis patients under biologic treatment, developed fewer psoriasis flares after COVID-19 vaccination (33.3%), than patients not under biologic treatment (66.6%) (p=0.0207; Fisher's exact test).
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Affiliation(s)
- Martina Burlando
- Section of Dermatology, Department of Health Sciences (DISSAL), San Martino Polyclinic Hospital IRCCS, University of Genoa, Genoa, Italy
| | - Astrid Herzum
- Section of Dermatology, Department of Health Sciences (DISSAL), San Martino Polyclinic Hospital IRCCS, University of Genoa, Genoa, Italy
| | - Emanuele Cozzani
- Section of Dermatology, Department of Health Sciences (DISSAL), San Martino Polyclinic Hospital IRCCS, University of Genoa, Genoa, Italy
| | - Aurora Parodi
- Section of Dermatology, Department of Health Sciences (DISSAL), San Martino Polyclinic Hospital IRCCS, University of Genoa, Genoa, Italy
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Ghashghaei S, Etemadifar Z, Tavassoli M, Mofid MR. Optimization of Degenerate PCR Conditions for Reducing Error Rates in Detection of PKS and NRPS Gene groups in Actinomycetes. Avicenna J Med Biotechnol 2023; 15:28-37. [PMID: 36789116 PMCID: PMC9895980 DOI: 10.18502/ajmb.v15i1.11422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 11/19/2022] [Indexed: 12/27/2022] Open
Abstract
Background The screen of Polyketide Synthase (PKS) and Nonribosomal Peptide Synthetase (NRPS) gene groups is a quick way to discover new therapeutic agents. However, errors in laboratory techniques cause a loss of touch with reality. This study aimed to evaluate the presence of PKS and NRPS gene groups in previously isolated strains by optimizing their specialized amplification by degenerate primers and indicating the evolutionary relationships with reference strains. Methods PKS-I, II, and NRPS genes PCR amplification was performed using three degenerate primer sets for 22 actinomycete strains with antibacterial activity. Annealing temperature and the amount of template DNA and primers were optimized. PCR products of PKS-I, II, and NRPS from three strains were sequenced after TA cloning. Besides, strains with high antibacterial activity were identified by biochemical features and partial 16S rDNA sequencing and hypothetically classified by a phylogenetic tree. Results High frequencies of PKS-I (86.4%), PKS-II (81.8%), and NRPS (95.4%) genes were found among the strains after optimization. Fourteen strains (64%) contained all of the genes, and 100% of strains had at least two genes. These numbers are pretty distinct in comparison with the previous researches. All of the sequenced strains were members of Streptomyces genus. Conclusion Our research showed that degenerate PCR strongly depends on the variation of annealing temperature and primer concentration, resulting in an unexpected shift in PCR outputs. The sequencing results confirmed the optimized conditions for specialized PCR of PKS-I, PKS-II, and NRPS gene groups.
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Affiliation(s)
- Sara Ghashghaei
- Department of Cell and Molecular Biology & Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Zahra Etemadifar
- Department of Cell and Molecular Biology & Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Manoochehr Tavassoli
- Department of Cell and Molecular Biology & Microbiology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Mohammad Reza Mofid
- Department of Biochemistry, Isfahan Pharmaceutical Sciences Research Center and Bioinformatics Research Center, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
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Khoo T, Sidhu N, Marine F, Lester S, Quinlivan A, Rowett D, Buchbinder R, Hill CL. Perceptions towards biologic and biosimilar therapy of patients with rheumatic and gastroenterological conditions. BMC Rheumatol 2022; 6:79. [PMID: 36550585 DOI: 10.1186/s41927-022-00309-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Biologic and targeted synthetic disease modifying agents (b/tsDMARDs) have broadened the treatment landscape for autoimmune diseases particularly in patients refractory to conventional DMARDs. More recently, the introduction of biosimilars has reduced the price of bDMARDs, potentially improving accessibility. Though efficacy and safety have been described, patient attitudes to b/tsDMARDs are not well-understood. We aim to investigate patients' beliefs about biologic and biosimilar therapy, and the factors influencing their perceptions. METHODS Patient consumer groups (Arthritis Australia, Crohn's and Colitis Australia) assisted in advertising an online questionnaire for people with a self-reported diagnosis of inflammatory arthritis (IA) or inflammatory bowel disease (IBD). The questionnaire incorporated the Belief about Medicines Questionnaire (BMQ) and the single-item literacy screener (SILS). Sources and favourability of biologic/biosimilar information were analysed, using the chi-square and a non-parametric trend test for unordered and ordered categorical variables respectively, comparing respondents with IA and IBD. RESULTS Eight hundred and thirty eight people (686-IA, 144-IBD, 8 both) responded. 658 (79%) used b/tsDMARDs. The BMQ demonstrated high necessity belief (median 4.2) with moderate concerns (median 2.8) about biologics. 95% of respondents obtained medication information from specialists though most used multiple sources (median 4). The most positive resources were specialists and specialist nurses. 73/141 (52%) respondents with IBD obtained information from specialist nurses compared with 202/685 (29%) with IA (p = 0.012). Respondents with limited reading ability on SILS were more likely to discuss information with a general practitioner or pharmacist. Younger respondents and those with higher BMQ concern scores more frequently consulted less reliable sources (e.g. social media). 502 respondents (60%) answered the biosimilar questions. Only 23 (4.6%) reported currently using a biosimilar and 336 (66.9%) were unsure if biosimilars were available in Australia. Specialist recommendation was the most frequent factor that would influence a patient to change from originator to biosimilar (352/495, 71.1%). CONCLUSIONS There is a high level of trust in specialists' recommendations about b/tsDMARDs, although most people also utilise additional information sources. Contextual factors influencing resource selection include age, reading ability and degree of concern about medicines. People with IA and IBD have similar attitudes though those with IBD more frequently access specialist nurse advice.
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Jairath V, Cohen RD, Loftus EV, Candela N, Lasch K, Schultz BG. Evaluating cost per remission and cost of serious adverse events of advanced therapies for ulcerative colitis. BMC Gastroenterol 2022; 22:501. [PMID: 36474165 PMCID: PMC9724317 DOI: 10.1186/s12876-022-02590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Determining the relative cost-effectiveness between advanced therapeutic options for ulcerative colitis (UC) may optimize resource utilization. We evaluated total cost per response, cost per remission, and cost of safety events for patients with moderately-to-severely active UC after 52 weeks of treatment with advanced therapies at standard dosing. METHODS An analytic model was developed to estimate costs from the US healthcare system perspective associated with achieving efficacy outcomes and managing safety outcomes for advanced therapies approved for the treatment of UC. Numbers needed to treat (NNT) for response and remission, and numbers needed to harm (NNH) for serious adverse events (SAEs) and serious infections (SIs) were derived from a network meta-analysis of pivotal trials. NNT for induction and maintenance were combined with drug regimen costs to calculate cost per clinical remission. Cost of managing AEs was calculated using NNH for safety outcomes and published costs of treating respective AEs. RESULTS Costs per remission were $205,240, $249,417, $267,463, $365,050, $579,622, $750,200, and $787,998 for tofacitinib 10 mg, tofacitinib 5 mg, infliximab, vedolizumab, golimumab, adalimumab, and ustekinumab, respectively. Incremental costs of SAEs and SIs collectively were $136,390, $90,333, $31,888, $31,061, $20,049, $12,059, and $0 for tofacitinib 5 mg, golimumab, adalimumab, tofacitinib 10 mg, infliximab, ustekinumab, and vedolizumab (reference), respectively. CONCLUSIONS Tofacitinib was associated with the lowest cost per response and cost per remission, while vedolizumab had the lowest costs related to SAEs and SIs. Balancing efficacy versus safety is important when evaluating the costs associated with treatment of moderate-to-severe UC.
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Affiliation(s)
- Vipul Jairath
- grid.39381.300000 0004 1936 8884Western University Schulich School of Medicine, London, ON Canada
| | - Russell D. Cohen
- grid.170205.10000 0004 1936 7822University of Chicago Pritzker School of Medicine, Chicago, IL USA
| | - Edward V. Loftus
- grid.66875.3a0000 0004 0459 167XMayo Clinic College of Medicine and Science, Rochester, MN USA
| | - Ninfa Candela
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave., Lexington, MA 02421 USA
| | - Karen Lasch
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave., Lexington, MA 02421 USA
| | - Bob G. Schultz
- grid.419849.90000 0004 0447 7762Takeda Pharmaceuticals U.S.A., Inc., 95 Hayden Ave., Lexington, MA 02421 USA ,grid.185648.60000 0001 2175 0319University of Illinois at Chicago College of Pharmacy, Chicago, IL USA
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Khoshakhlagh A, Aghaei SS, Abroun S, Soleimani M, Zolfaghari MR. Investigation of diverse biosynthetic secondary metabolites gene clusters using genome mining of indigenous Streptomyces strains isolated from saline soils in Iran. Iran J Microbiol 2022; 14:881-890. [PMID: 36721452 PMCID: PMC9867626 DOI: 10.18502/ijm.v14i6.11263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background and Objectives Bioactive secondary metabolites are the products of microbial communities adapting to environmental challenges, which have yet remained anonymous. As a result of demands in the pharmaceutical, agricultural, and food industries, microbial metabolites should be investigated. The most substantial sources of secondary metabolites are Streptomyces strains and are potential candidates for bioactive compound production. So, we used genome mining and bioinformatics to predict the isolates secondary metabolites, biosynthesis, and potential pharmaceuticals. Materials and Methods This is a bioinformatics part of our previous experimental research. Here, we aimed to inspect the underlying secondary metabolite properties of 20 phylogenetically diverse Streptomyces species of saline soil by a rationalized computational workflow by several software tools. We examined the Metabolites' cytotoxicity and antibacterial effects using the MTT assay and plate count technique, respectively. Results Among Streptomyces species, three were selected for genome mining and predicted novel secondary metabolites and potential drug abilities. All 11 metabolites were cytotoxic to A549, but ectoine (p≤0.5) and geosmin (p≤0.001) significantly operated as an anti-cancer drug. Metabolites of oxytetracycline and phosphinothricin (p≤0.001), 4Z-annimycin and geosmin (p≤0.01), and ectoine (p≤0.5) revealed significant antibacterial activity. Conclusion Of all the 11 compounds investigated, annimycin, geosmin, phosphinothricin, and ectoine had antimicrobial properties, but geosmin also showed very significant anti-cancer properties.
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Affiliation(s)
- Amin Khoshakhlagh
- Department of Microbiology, Qom Branch, Islamic Azad University, Qom, Iran
| | - Seyed Soheil Aghaei
- Department of Microbiology, Qom Branch, Islamic Azad University, Qom, Iran,Corresponding author: Seyed Soheil Aghaei, Ph.D, Department of Microbiology, Qom Branch, Islamic Azad University, Qom, Iran. Tel: +98-25-32808080 Fax: +98-25-32804040
| | - Saeid Abroun
- Department of Hematology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mohammad Soleimani
- Department of Microbiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
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Kern JS, Hofmann SC. [Management of bullous pemphigoid and mucous membrane pemphigoid]. Dermatologie (Heidelb) 2022; 74:927-936. [PMID: 37843581 DOI: 10.1007/s00105-023-05241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Bullous pemphigoid (BP) is the most common blistering autoimmune dermatosis and, as an age-associated disease, is also the bullous dermatosis with the highest increase in incidence in recent years due to demographic developments. Mucous membrane pemphigoid (MMP), which is less common, is a clinically and immunopathologically heterogeneous blistering autoimmune dermatosis characterized by blisters and erosions on mucous membranes. OBJECTIVE This work summarizes the manifold clinical characteristics of both diseases and provides an up-to-date overview of diagnostics and therapy of BP and SHP. MATERIALS AND METHODS A selective literature search was carried out. RESULTS While eczematous, urticarial, or bullous lesions on the integument are typical for BP, MMP is characterized by pronounced, erosive mucosal changes orally, ocularly, genitoanally, tracheally or esophageally and, at most, only minor skin involvement. For diagnosis, the combination of histology, direct immunofluorescence microscopy, and serological detection of autoantibodies against the hemidesmosomal proteins BP180 and BP230 and, in MMP, also against laminin 332 is important. New pathophysiological findings and therapeutics have recently significantly expanded the range of treatment options. CONCLUSION Due to the comorbidities of the usually elderly BP patients and the often multiple affected mucous membranes in MMP, with the risk of developing irreversible complications such as strictures and synechiae, interdisciplinary diagnosis and therapy is often required.
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Affiliation(s)
- Johannes S Kern
- Department of Dermatology, Alfred Hospital, Central Clinical School, Monash University, 55 Commercial Road, 3004, Melbourne Victoria, Australien.
| | - Silke C Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, HELIOS Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstr. 40, 42283, Wuppertal, Deutschland.
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22
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Oh S, Choi S, Yoon HS. Available Alternative Biologics and Disease Groups Influence Biologic Drug Survival in Patients with Psoriasis and Psoriatic Arthritis. Ann Dermatol 2022; 34:321-330. [PMID: 36198623 PMCID: PMC9561298 DOI: 10.5021/ad.22.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/21/2022] [Accepted: 04/24/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Factors other than efficacy and safety could influence the survival of biologics in patients with psoriasis. Little is known about whether different disease groups affect drug survival of biologics or not. OBJECTIVE This study aimed to investigate whether the availability of alternative biologics and disease groups could influence drug survival of biologics approved for psoriasis and psoriasis arthritis (PsA). METHODS A nationwide population-based retrospective cohort study was conducted using the Health Insurance and Review Assessment data in Korea between January 2009 and August 2019. RESULTS The drug survival analysis included 5,634 biologic episodes. Ustekinumab was the most frequently prescribed drug (n=2,488, 44.2%). Multivariable time-dependent Cox regression analysis showed that higher age, female sex, no comorbidity, concomitant cyclosporine or acitretin use, biologic-experienced and use of tumor necrosis factor (TNF)-α inhibitors were predictors of drug discontinuation. PsA was a predictor of drug persistence, particularly for TNF-α inhibitors. Ustekinumab and adalimumab discontinuation significantly increased after introducing secukinumab and ustekinumab, respectively. CONCLUSION The availability of alternative biologics and disease groups affect biologic drug survival in patients with psoriasis and PsA.
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Affiliation(s)
- Sohee Oh
- Department of Biostatistics, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Sungjun Choi
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Hyun-Sun Yoon
- Department of Dermatology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea
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23
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Moran GW, Kurtzman JT, Carpenter CP. Biologic adjuvant urethral coverings for single-stage primary hypospadias repairs: A systematic review and pooled proportional meta-analysis of postoperative urethrocutaneous fistulas. J Pediatr Urol 2022; 18:598-608. [PMID: 36085187 DOI: 10.1016/j.jpurol.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/09/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The use of barrier layers between the neourethra and skin is associated with lower rates of post-operative urethrocutaneous fistula (UCF) following hypospadias surgery. Recent studies have evaluated the ability of biologic adjuvant urethral coverings (BAUCs) - namely acellular matrix (AM), tissue adhesives (TAs), and autologous platelet-rich plasma or fibrin (PRP/PRF) - to prevent wound complications following hypospadias surgery. In general, however, these studies are small and conducted at single institutions. OBJECTIVE To assess the effect of BAUCs on the rate of UCF following single-stage primary hypospadias repair. METHODS We conducted a systematic review of studies reporting the rate of postoperative UCF in pediatric patients undergoing single-stage, primary hypospadias repairs using either AM, TA, or PRP/PRF as a layer interposed between the neourethra and skin. We then performed a pooled proportional meta-analysis of post-operative UCF. Patients within each study who underwent comparable surgery but did not receive a BAUC were used as controls. RESULTS 10 studies were included in our review. The meta-analysis included 280 patients from 7 studies who underwent hypospadias repairs with BAUCs. The pooled incidence of UCF was 10% (95% CI 6-14%). Mean follow-up ranged 5-23.5 months in the 5/7 studies reporting specific durations, and ≥6 month and 14-30 months, respectively, in the other two studies. Patients in whom a BAUC was used had significantly lower odds of UCF than control patients (OR 0.39, 95% CI 0.24-0.64, p = 0.0002). In subgroup analyses, significant superiority held for AM and TA; proximal or penoscrotal cases; transverse preputial island flap (TPIF) technique; when both cases and controls had local flaps; and when neither cases nor controls had flaps. DISCUSSION The use of BAUCs was associated with decreased rates of post-operative UCF in single-stage primary hypospadias repairs and may be most beneficial in more severe cases and when used in addition to local flaps or when using a flap is not possible. In 2/3 studies of PRP/PRF and 2/4 studies of tubularized incised plate (TIP) technique, dartos flaps were used in controls but not BAUC patients, which may explain the lack of benefit demonstrated for these subgroups. This meta-analysis is limited by the quality of evidence in the included studies, which are not uniformly randomized. Furthermore, the follow-up durations and methods for assessing complications are not standardized between included studies. CONCLUSION The meta-analysis herein suggests that using BAUCs may reduce UCF rates following hypospadias surgery. Rigorous prospective evaluation is needed to validate this benefit.
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Affiliation(s)
- George W Moran
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA.
| | - Jane T Kurtzman
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA
| | - Christina P Carpenter
- Department of Urology, Columbia University Irving Medical Center, New York, NY, USA; Division of Pediatric Urology, New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA
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24
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Kempski J, Huber S. [Role of the gut microbiome in the pathogenesis and treatment of inflammatory bowel diseases]. Inn Med (Heidelb) 2022; 63:1022-1027. [PMID: 36044059 DOI: 10.1007/s00108-022-01396-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Inflammatory bowel diseases (IBD) are systemic diseases that mainly manifest in the gastrointestinal tract. Due to chronically impaired intestinal homeostasis, they often require permanent and in some cases systemic therapy. The exact causes of IBD are largely unknown. It is postulated that these complex diseases arise in genetically susceptible individuals through a misdirected immune response, promoted by barrier defects, environmental toxins, and the gut microbiome. In this regard, the importance of the microbiome and its pathogenic changes (dysbiosis) in the pathogenesis of IBD is increasingly coming into focus. This review article presents the current state of research on the role of the microbiome in the development of IBD. Therapeutic approaches aimed at correcting intestinal dysbiosis are also discussed.
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Affiliation(s)
- Jan Kempski
- I. Medizinische Klinik und Poliklinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - Samuel Huber
- I. Medizinische Klinik und Poliklinik, Zentrum für Innere Medizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
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25
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Kido LA, Rossetto IMU, Baseggio AM, Chiarotto GB, Alves LF, Santos FR, Lamas CDA, Jr MRM, Cagnon VHA. Brazilian Berry Extract Differentially Induces Inflammatory and Immune Responses in Androgen Dependent and Independent Prostate Cancer Cells. J Cancer Prev 2022; 27:182-191. [PMID: 36258714 PMCID: PMC9537582 DOI: 10.15430/jcp.2022.27.3.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 11/07/2022] Open
Abstract
Jaboticaba is a Brazilian berry, which is rich in fibers and bioactive compounds and shows high antioxidant and antiproliferative activities. Prostate cancer (PCa) is the second most common type of cancer among men and its progression is influenced by androgens and inflammation. Previous studies reported the ability of the jaboticaba to modulate pathways involved in prostate diseases. The main objective of this study was to provide significant data about molecular targets of the jaboticaba peel extract (JPE) and its mechanisms of action in PCa cell lines with different androgenic status (LNCaP and PC-3). The results showed that JPE was able to decrease cell viability in both cell lines. LNCaP showed more sensitivity to JPE exposure, indicating the efficacy of the JPE treatment in terms of androgen responsiveness. JPE showed a distinct hormone dependent effect on the NF-κB signaling, with reduced NF-κB levels for LNCaP and increased NF-κB levels in PC-3 cells. Mechanisms related to cell death by apoptosis were stimulated after the JPE treatment, modulating B-cell lymphoma 2 and BAX for LNCaP and PC-3. Particularly for PC-3, the JPE treatment resulted in cytokine-cytokine receptor interaction activation mostly by up regulating pro-inflammatory, pro-angiogenic, immunostimulatory and immunosuppressive genes. Also, a set of genes related to angiogenesis and metastasis were down-regulated by JPE. In conclusion, JPE exerted an antitumor effect on PCa for both cell lines which can be enhanced if androgenic reliance is considered.
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Affiliation(s)
- Larissa Akemi Kido
- Department of Structural and Functional Biology, Institute of Biology, São Paulo, Brazil,Department of Food and Nutrition, Faculty of Food Engineering, University of Campinas, São Paulo, Brazil,Correspondence to Larissa Akemi Kido, E-mail: , https://orcid.org/0000-0002-3653-8035
| | | | - Andressa Mara Baseggio
- Department of Food and Nutrition, Faculty of Food Engineering, University of Campinas, São Paulo, Brazil
| | | | - Letícia Ferreira Alves
- Department of Structural and Functional Biology, Institute of Biology, São Paulo, Brazil
| | - Felipe Rabelo Santos
- Department of Structural and Functional Biology, Institute of Biology, São Paulo, Brazil
| | | | - Mário Roberto Maróstica Jr
- Department of Food and Nutrition, Faculty of Food Engineering, University of Campinas, São Paulo, Brazil
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26
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Lim SW, Shin YJ, Cui S, Ko EJ, Yoo SH, Chung BH, Yang CW. Therapeutic effect of multiple functional minicircle vector encoding anti-CD25/IL-10/CXCR3 in allograft rejection model. Korean J Intern Med 2022; 37:1031-1049. [PMID: 35725307 PMCID: PMC9449213 DOI: 10.3904/kjim.2021.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND/AIMS We previously proposed minicircle vector technology as the potential platform for the development and production of new biologics. In this study, we have designed a novel target molecule for the treatment of allograft rejection and evaluated its feasibility as the therapeutic agent in this disease using the minicircle vector system. METHODS We engineered vectors to carry cassette sequences for anti-CD25, interleukin-10 (IL-10), and C-X-C motif chemokine receptor 3 (CXCR3) fusion protein, and then isolated minicircle vectors from the parent vectors. We verified the substantial production of anti-CD25/IL-10/CXCR3 fusion protein from minicircles and their duration in HEK293T cells and mice models. We also evaluated whether minicircle-derived anti-CD25/IL-10/CXCR3 has therapeutic effects in a skin allograft in mice model. RESULTS We confirmed the production of anti-CD25/IL-10/CXCR3 from minicircle by its significant availability in cells transfected with the minicircle and in its conditioned media. After a single injection of minicircle by hydrodynamic injection via mouse tail vein, luminescence or red fluorescence was maintained until 40 days in the liver tissue, suggesting the production of anti-CD25/IL-10/CXCR3 protein from minicircles via protein synthesis machinery in the liver. Mice treated with the minicircle encoding anti-CD25/IL-10/CXCR3 showed prolonged skin allograft survival times accompanied by improved immunologic regulation e.g., reduction of the lymphocyte population of Th1, Th2, and Th17 and an induction of regulatory T cells. CONCLUSION These findings implied that self-generated anti-CD25/IL-10/CXCR3 protein drug by minicircle technology is functionally active and relevant for reducing allograft rejection. The minicircle vector system may be useful for developing new biological drugs, avoiding manufacturing or practical problems.
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Affiliation(s)
- Sun Woo Lim
- Transplant Research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Yoo Jin Shin
- Transplant Research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sheng Cui
- Transplant Research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Eun Jeong Ko
- Transplant Research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | | | - Byung Ha Chung
- Transplant Research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Chul Woo Yang
- Transplant Research Center, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Convergent Research Consortium for Immunologic Disease, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Division of Nephrology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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27
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Na SY, Kim YS. Management of inflammatory bowel disease beyond tumor necrosis factor inhibitors: novel biologics and small-molecule drugs. Korean J Intern Med 2022; 37:906-919. [PMID: 35945034 PMCID: PMC9449214 DOI: 10.3904/kjim.2022.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/15/2022] [Indexed: 11/27/2022] Open
Abstract
The incidence and prevalence of inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, have increased in Asia and developing countries. In the past two decades, anti-tumor necrosis factor (TNF) agents have revolutionized the treatment of IBD, in part by decreasing the rates of complications and surgery. Although anti-TNF agents have changed the course of IBD, there are unmet needs in terms of primary and secondary non-responses and side effects such as infections and malignancies. Novel biologics and small-molecule drugs have been developed for IBD, and the medical treatment options have improved. These drugs include sphingosine-1-phosphate receptor modulators and anti-integrins to block immune cell migration, and cytokine and Janus kinase inhibitors to block immune cell communications. In this review, we discuss the approved novel biologics and small-molecule drugs, including several of those in the late stages of development, for the treatment of IBD.
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Affiliation(s)
- Soo-Young Na
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon,
Korea
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine, Seoul,
Korea
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28
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Pradeau M, Ghoreschi K, Meier K. [Mucosal lichen planus-a diagnostic and therapeutic challenge]. Dermatologie (Heidelb) 2022; 73:670-681. [PMID: 35943534 DOI: 10.1007/s00105-022-05034-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Mucosal lichen planus (MLP) is a chronic inflammatory disease of the mucosa. This condition can affect the mouth, esophagus, pharynx, genitalia, anus, and conjunctiva. This disease shows a tendency to chronicity with phases of relapses for a duration of 3-10 years. It presents with varying morphologies including lacy or fern-like, slightly raised striae, erosions, erythema, and atrophy. The pathophysiology is not yet fully understood and is dominated by the classic band-like lymphocytic infiltrate along the dermoepidermal junction. MLP is very challenging to treat, since the clinical course entails frequent relapses and shows resistance to therapy. The most commonly used local treatments are topical corticosteroids or calcineurin inhibitors. In addition to systemic glucocorticosteroids and traditional systemic drugs such as oral retinoids or methotrexate, emerging anti-inflammatory therapies such as Janus kinase inhibitors and biologics may be promising and are currently being evaluated in clinical trials.
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Affiliation(s)
- Marie Pradeau
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Kamran Ghoreschi
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Katharina Meier
- Department of Dermatology, Venereology and Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
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29
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Choi B, Park HJ, Song YK, Oh YJ, Kim IW, Oh JM. The risk of newly diagnosed cancer in patients with rheumatoid arthritis by TNF inhibitor use: a nationwide cohort study. Arthritis Res Ther 2022; 24:191. [PMID: 35945635 PMCID: PMC9364556 DOI: 10.1186/s13075-022-02868-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Tumor necrosis factor (TNF) inhibitors use in patients with rheumatoid arthritis (RA) has raised safety concerns about cancer risk, but study results remain controversial. This largest nationwide study to date compared cancer risk in TNF inhibitor users to non-biologic disease-modifying anti-rheumatic drug (nbDMARD) users in Korean patients with RA. Methods Data on all the eligible patients diagnosed with RA between 2005 and 2016 were retrieved from the Korean National Health Information Database. The one-to-one matched patients consisted of the matched cohort. The risks for developing all-type and site-specific cancers were estimated using incidence and incidence rate (IR) per 1000 person-years. Adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated using a Cox regression model. Results Of the 22,851 patients in the before matching cohort, 4592 patients were included in the matched cohort. Treatment with TNF inhibitors was consistently associated with a lower risk of cancer than in the nbDMARD cohort (IR per 1000 person-years, 6.5 vs. 15.6; adjusted HR, 0.379; 95% CI, 0.255–0.563). The adjusted HR (95% CI) was significantly lower in the TNF inhibitor cohort than the nbDMARD cohort for gastrointestinal cancer (0.432; 0.235–0.797), breast cancer (0.146; 0.045–0.474), and genitourinary cancer (0.220; 0.059–0.820). Conclusions The use of TNF inhibitors was not associated with an increased risk of cancer development, and rather associated with a lower cancer incidence in Korean patients with RA. Cautious interpretation is needed not to oversimplify the study results as cancer-protective effects of TNF inhibitors. A further study linking claims and clinical data is needed to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02868-w.
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Affiliation(s)
- Boyoon Choi
- Department of Pharmacy, College of Pharmacy and Institute of Pharmaceutical Sciences, CHA University, Pocheon-si, Gyeonggi, Republic of Korea
| | - Hyun Jin Park
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Yun-Kyoung Song
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,College of Pharmacy, Daegu Catholic University, Gyeongsan-si, Gyeongbuk, Republic of Korea
| | - Yoon-Jeong Oh
- Division of Rheumatology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon-si, Kangwon, Republic of Korea
| | - In-Wha Kim
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Jung Mi Oh
- College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.
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30
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Jun YK, Yoon H, Koh SJ, Kim AH, Kim KW, Park JW, Lee HJ, Kang HW, Im JP, Park YS, Kim JS. Concomitant ankylosing spondylitis can increase the risk of biologics or small molecule therapies to control inflammatory bowel disease. Intest Res 2022; 21:244-251. [PMID: 35929093 PMCID: PMC10169522 DOI: 10.5217/ir.2022.00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022] Open
Abstract
Background/Aims Patients with inflammatory bowel disease (IBD) are diagnosed with ankylosing spondylitis (AS) often. However, the disease course of patients with both IBD and AS is not well understood. This study aims to evaluate the effect of concomitant AS on IBD outcomes. Methods Among the 4,722 patients with IBD who were treated in 3 academic hospitals from 2004 to 2021, 55 were also diagnosed with AS (IBD-AS group). Based on patients' electronic medical records, the outcomes of IBD in IBD-AS group and IBD group without AS (IBD-only group) were appraised. Results The proportion of patients treated with biologics or small molecule therapies was significantly higher in IBD-AS group than the proportion in IBD-only group (27.3% vs. 12.7%, P= 0.036). Patients with both ulcerative colitis and AS had a significantly higher risk of biologics or small molecule therapies than patients with only ulcerative colitis (P< 0.001). For univariable logistic regression, biologics or small molecule therapies were associated with concomitant AS (odds ratio, 4.099; 95% confidence interval, 1.863-9.021; P< 0.001) and Crohn's disease (odds ratio, 3.552; 95% confidence interval, 1.590-7.934; P= 0.002). Conclusions Concomitant AS is associated with the high possibility of biologics or small molecule therapies for IBD. IBD patients who also had AS may need more careful examination and active treatment to alleviate the severity of IBD.
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Affiliation(s)
- Yu Kyung Jun
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyuk Yoon
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.,Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Joon Koh
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - A Hyeon Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Kwang Woo Kim
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jun Won Park
- Seoul National University College of Medicine, Seoul, Korea.,Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun Jung Lee
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyoun Woo Kang
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jong Pil Im
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Soo Park
- Division of Gastroenterology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Sung Kim
- Seoul National University College of Medicine, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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31
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Abtahi S, Cordtz R, Dreyer L, Driessen JHM, Boonen A, Burden AM. Biological Disease-Modifying Antirheumatic Drugs and Osteoporotic Fracture Risk in Patients with Rheumatoid Arthritis: A Danish Cohort Study. Am J Med 2022; 135:879-888.e3. [PMID: 35134369 DOI: 10.1016/j.amjmed.2022.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 01/06/2022] [Accepted: 01/14/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Clinical trials have shown a beneficial effect from biological disease-modifying antirheumatic drugs (bDMARDs) on hand or axial bone loss in patients with rheumatoid arthritis; however, it is unclear if this translates to a reduced fracture risk. We investigated the effect of bDMARDs on osteoporotic fracture risk compared to no biological treatment in rheumatoid arthritis. METHODS A cohort of patients with rheumatoid arthritis aged 18+ from DANBIO was linked to population-based health registries in Denmark (2006-2016). Adopting a prevalent new-user design, we matched bDMARD users to bDMARD-naïve patients using time-conditional propensity scores. The risk of incident osteoporotic fractures (including hip, vertebrae, humerus, and forearm) was estimated among the matched patients by Cox proportional hazards models. RESULTS Out of 24,678 patients with rheumatoid arthritis, 4265 bDMARD users were matched to the same number of bDMARD-naïve patients (mean age 56.2 years, 74% female). During follow-up, 229 osteoporotic fractures occurred among bDMARD users and 205 fractures among bDMARD-naïve patients (incidence rates 12.1 and 13.0 per 1000 person-years, respectively). The use of bDMARDs was not associated with a reduced risk of osteoporotic fractures among patients with rheumatoid arthritis (hazard ratio 0.97, 95% confidence interval 0.78-1.20), compared with no biological treatment. The risk estimates were similar for all osteoporotic fracture sites. CONCLUSION We found no independent beneficial effect from using bDMARDs on reducing the risk of osteoporotic fractures in patients with rheumatoid arthritis.
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Affiliation(s)
- Shahab Abtahi
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - René Cordtz
- Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Lene Dreyer
- Departments of Clinical Medicine and Rheumatology, Aalborg University and Aalborg University Hospital, Aalborg, Denmark; DANBIO - The Danish Rheumatologic Database, Copenhagen, Denmark
| | - Johanna H M Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Andrea M Burden
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre, Maastricht, the Netherlands; Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland.
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Fakhri M, Fakheri H, Azadbakht M, Moosazadeh M, Yousefi SS. Effect of Medicinal Plants and Natural Products on Liver Enzymes in Non-alcoholic Fatty Liver Patients in Iran: A Systematic Review and Meta-Analysis. Int J Prev Med 2022; 13:87. [PMID: 35958359 PMCID: PMC9362742 DOI: 10.4103/ijpvm.ijpvm_313_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Nonalcoholic fatty liver is the most common chronic liver disease. Regarding the side effects of synthetic medicines and the variety of natural products in Iran climate, the present study aimed to investigate the effect of medicinal plants and natural products on liver enzymes in patients with non-alcoholic fatty liver disease in Iran using meta-analysis. Methods To extract the intended studies, internal and external databases, including SID, Magiran, IranDoc, PubMed, Scopus, Web of Science, Embase, Cochrane, and Clinical Trial Registration System of Clinical trial.gov, the ISRCTN system, as well as Clinical Trial Registration System affiliated to the World Health Organization were searched. The obtained data were analyzed in STATA.14 software. A P value less than 0.05 was considered statistically significant. Results A total of 44 rstudies were reviewed with a sample size of 1298 participant; they were published in the period from 2009 to 2018, silymarin had the highest effect on the reduction of AST (SMD = -2.68), cinnamon excreted the most profound effect on ALT (SMD = -2.69). In addition, cinnamon had the highest effect on gamma-glutamyl transferase (GGT) (SMD:-3.17), and curcumin had the highest effect on alkaline phosphatase (ALP) (SMD = -1.88). In the lipid profile, the effect of medicinal herbs and natural products on lowering total cholesterol and LDL was statistically significant. In the glycemic profile, the effect of medicinal plants and natural products on the reduction of fasting blood sugar, insulin, and hemoglobin A1c levels was statistically significant. Conclusions As evidenced by the obtained results, the highest effect of using natural products was observed in the reduction of GGT, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels, respectively; nonetheless, the effect of natural products on ALP reduction was not statistically significant.
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Affiliation(s)
- Moloud Fakhri
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran,School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,Address for correspondence: Dr. Moloud Fakhri, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. E-mail:
| | - Hafez Fakheri
- Gut and Liver Research Center, Non-communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Azadbakht
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran,Department of Pharmacognosy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyde Sedighe Yousefi
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran,Department of Persian Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran,Dr. Seyde Sedighe Yousefi, Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran. Department of Persian Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran E-mail:
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Kudsi M, Alzabibi MA, Shibani M. Two cases of Erythrodermic psoriasis treated with Golimumab. Ann Med Surg (Lond) 2022; 78:103961. [PMID: 35734731 PMCID: PMC9207129 DOI: 10.1016/j.amsu.2022.103961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction and importance Erythrodermic psoriasis (EP) is a very severe subtype of psoriasis, with a challenge poses in its treatment, as currently available therapies often provide unsatisfactory results, for those many biologics have been used in the treatment of EP such as Golimumab which has been extensively studied for the treatment of psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for EP. Case presentation We report two cases of a 23-year old female, and a 31-year male who presented with severe psoriasis that previously un respond to ultraviolet B phototherapy, methotrexate, cyclosporine, and topical agents. Skin lesions worsened progressively and developed into erythroderma. Therefore, we administered golimumab 50 mg, which lead to the improvement of the skin lesions according to the Psoriasis Area and Severity Index score after the first administration; lesions improved further throughout the treatment course. Conclusion Golimumab may be an alternative treatment for Erythrodermic psoriasis patients unrespond to other treatments even it did not have the FDA approval, so this is an off label indication and treatment. Erythrodermic psoriasis is a very severe subtype of psoriasis, with a challenge poses in its treatment. Golimumab is tumor necrosis factor inhibitors. Golimumab is FDA approved treatment for psoriatic arthritis, and chronic plaque psoriasis. However, no clinical trials have been performed for the treatment of erythrodermic psoriasis.
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Affiliation(s)
- Mayssoun Kudsi
- Faculty of Medicine, Syrian Private University, Damascus, Syria.,Faculty of Medicine, Damascus University, Damascus, Syria
| | | | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Damascus, Syria
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da Nóbrega Alves D, Melo AKV, Alves AF, de Araújo MRC, da Silva Araújo R, de Castro RD. Safety and tolerability of cinnamaldehyde in orabase for oral candidiasis treatment: phase I clinical trial. Clin Oral Investig 2022. [PMID: 35305150 DOI: 10.1007/s00784-022-04450-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/12/2022] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To advance studies on the effect of a new pharmaceutical formulation for the treatment of oral fungal infections, we evaluated the safety and tolerability of orabase ointment containing cinnamaldehyde for use on the oral mucosa. MATERIAL AND METHODS A clinical trial (phase I) was carried out on 35 individuals with healthy oral mucosa divided into three groups: ointments at 200 µg/mL, n = 12; 300 µg/mL, n = 11; and 400 µg/mL, n = 12. Product safety was assessed using three parameters: (a) clinical evolution as recorded by trained examiners; (b) evolution of the inflammatory process as registered by an exfoliative cytology exam and analyzed by trained pathologists; (c) mucosal swab to count Candida spp. colony-forming units (CFU). These parameters were analyzed both beforehand and at 15 days of treatment. RESULTS The three ointment concentrations evaluated did not trigger inflammatory processes. The mycological analyses revealed a reduction of at least 99% in the number of Candida spp. CFU. In the exfoliative cytology analyses, the cells were found to be healthy. Participants reported a pleasant taste, yet 17% reported a slight burning sensation when applying the product. CONCLUSIONS The ointment is safe and tolerable for use on healthy oral mucosa. TRIAL REGISTRATION Registration number: RBR-7zwzs3. CLINICAL RELEVANCE The ointment proved to be safe and tolerable for use on oral mucosa, encouraging studies to evaluate its clinical efficacy in patients with oral candidiasis, and contributing to a new therapeutic proposal for the treatment of fungal infections caused by Candida spp.
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Kim SH, Lee H, Park SY, Park SY, Song WJ, Kim JH, Park HW, Cho YS, Yoon HJ. The Korean Severe Asthma Registry (KoSAR): real world research in severe asthma. Korean J Intern Med 2022; 37:249-260. [PMID: 35184515 PMCID: PMC8925953 DOI: 10.3904/kjim.2021.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Severe asthma constitutes a serious health burden with significant morbidity and socioeconomic costs. The development and introduction of new biologics targeting type 2 inflammation changed the paradigm for management of severe asthma and initiated a biological era. These changes impose a challenge to clinicians in managing difficult-to-treat and severe asthma. To understand the characteristics and heterogeneity of severe asthma and to develop a better strategy to manage it, the Korean Academy of Asthma, Allergy and Clinical Immunology, Working Group on Severe Asthma, has organized the Korean Severe Asthma Registry (KoSAR). In this review, we describe the challenges of severe asthma management regarding diagnosis, disease burden, heterogeneity, guidelines, and organization of severe asthma clinics. This review also examines the current global activities of national and regional registries and study groups. In addition, we present the KoSAR vision and organization and describe the findings of KoSAR in comparison with those of other countries.
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Affiliation(s)
- Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - So-Young Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - So Young Park
- Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
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Tajbakhsh E, Khamesipour A, Hosseini SR, Kosari N, Shantiae S, Khamesipour F. The effects of medicinal herbs and marine natural products on wound healing of cutaneous leishmaniasis: A systematic review. Microb Pathog 2021; 161:105235. [PMID: 34648927 DOI: 10.1016/j.micpath.2021.105235] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 02/05/2023]
Abstract
This study aimed to investigate the effects of medicinal herbs and marine natural products on wound healing of cutaneous leishmaniasis. To carry out this literature review, the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) instructions were used. Articles on the potential of medicinal plants and natural substances of marine origin against wound healing of cutaneous leishmaniasis were explored. The scientific databases considered were PubMed, Science Direct, Google Scholar, Web of Science, Scopus, and SpringerLink. The scientific documents collected were mainly scientific articles, books, book chapters, and doctoral thesis. The research considered 73 manuscripts published in the period from 1990 to 2020. From all the data collected, it appears that the scientific literature is rich in medicinal herbs and marine products to be valorized in the wound healing of cutaneous leishmaniasis. We have identified 15 medicinal plants traditionally used in the management of healing or ulcer of cutaneous leishmaniasis, 32 medicinal plants whose efficacy has been demonstrated in vitro or in vivo against cutaneous leishmaniasis, 5 marine products active against cutaneous leishmaniasis. It is also clear that the option of medicinal herbs/marine products in the management of cutaneous leishmaniasis is less expensive and allows to avoid the side effects of conventional products. It is necessary to encourage the development of dermatological topicals for the management of cutaneous leishmaniasis based on the data collected. In vivo research should be intensified on medicinal herbs traditionally used in wound healing of cutaneous leishmaniasis.
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Affiliation(s)
- Elahe Tajbakhsh
- Department of Microbiology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Ali Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Neda Kosari
- Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Shima Shantiae
- Department of Microbiology, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Faham Khamesipour
- Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran; Shahrekord Branch, Islamic Azad University, Shahrekord, Iran.
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Romero RK, Magro DO, Queiroz NSF, Damião AOMC, Teixeira FV, Nones RB, Sassaki LY, Saad-Hossne R, Kotze PG. Perception and clinical decisions from inflammatory bowel diseases' specialists towards positioning of new therapies in Crohn's disease and ulcerative colitis: A national web-based survey from the Brazilian IBD study group (GEDIIB). Gastroenterol Hepatol 2021; 45:499-506. [PMID: 34634427 DOI: 10.1016/j.gastrohep.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In the last decade, new therapies with different mechanisms of action have been approved for the treatment of moderate to severe Crohn's disease (CD) and ulcerative colitis (UC). Due to the lack of comparative head-to-head trials, the ideal positioning of agents as the most appropriate first- or second-line therapies remains to be defined. OBJECTIVE This survey aimed to evaluate the perception and decisions of Brazilian Inflammatory Bowel Diseases (IBD) specialists in positioning of new therapies (vedolizumab [VEDO], ustekinumab [UST] and tofacitinib [TOFA]) in the management of IBD in different clinical scenarios. METHODOLOGY An anonymous national web-based questionnaire was used to determine the positioning of treatment options in different clinical scenarios (using Google Forms platform), which involved different age ranges, phenotypes, clinical situations and previous exposure to anti-TNF agents (14 scenarios for CD and 10 scenarios for UC). In CD, physicians could choose between UST or VEDO, whilst in UC, between UST, VEDO or TOFA. Six reasons for the specific choice were proposed, such as mechanism of action, safety, method of administration or onset of action. Statistical analysis was carried out with chi-square and t-tests. RESULTS A total of 150 out of 672 GEDIIB IBD specialists (22.32%) responded to the survey. In CD scenarios, UST was the most dominant choice (11/14 scenarios), with VEDO dominating only 3 clinical situations. In UC scenarios, VEDO was the dominant choice (8/10), with UST being chosen for scenarios that included extraintestinal manifestations. Among the reasons for specific choices, the most commonly chosen were the higher efficacy due to the intrinsic mechanism of action and safety profile. CONCLUSIONS UST was the dominant choice as compared to VEDO in CD in most scenarios, especially due to its mechanism of action and safety. VEDO was the dominant choice as compared to UST and TOFA in UC scenarios, mainly for reasons also related to its mechanism of action and safety profile. Comparative studies including patient outcomes are needed to better define the positioning of new IBD therapeutic options in our country.
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Kim J, Koh JH, Choi SJ, Jeon CH, Kwok SK, Kim SK, Choi CB, Lee J, Lee C, Nam EJ, Park YB, Lee SS, Kim TH, Park SH, Koh EM, Yoo DH, Song YW, Kim HA, Shin K. KOBIO, the First Web-based Korean Biologics Registry Operated With a Unified Platform Among Distinct Disease Entities. J Rheum Dis 2021; 28:176-182. [PMID: 37476366 PMCID: PMC10324910 DOI: 10.4078/jrd.2021.28.4.176] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/11/2021] [Accepted: 07/26/2021] [Indexed: 07/22/2023]
Abstract
The KOrean College of Rheumatology BIOlogics and targeted therapy (KOBIO) registry is a nationwide observational cohort that captures detailed data on exposure of patients to biologic and targeted synthetic disease-modifying anti-rheumatic drugs (DMARDs). This registry was launched in December 2012 with an aim to prospectively investigate clinical manifestations and outcomes of patients with rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis who initiated a biologic or targeted synthetic DMARD or switched to another. Demographic data, disease activity, current treatment, adverse events, terms based on Medical Dictionary for Regulatory Activities, and so on are registered for patients who are then followed up annually in a web-based unified platform. The KOBIO registry also recruits and collects data of patients with RA on conventional DMARDs for comparison. As of today, more than 5,500 patients were enrolled from 47 academic and community Rheumatology centers across Korea. The KOBIO registry has evolved to become a powerful database for clinical research to improve clinical outcomes and quality of treatment.
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Affiliation(s)
- Jinhyun Kim
- Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Jae Choi
- Division of Rheumatology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Chan Hong Jeon
- Division of Rheumatology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seung-Ki Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Chan-Bum Choi
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jaejoon Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Changhoon Lee
- Department of Internal Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Eon Jeong Nam
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yong-Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Hospital, Gwangju, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Mi Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Kichul Shin
- Division of Rheumatology, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
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Körber A, Augustin M, Behrens F, Gerdes S, von Kiedrowski R, Schäkel K, Sticherling M, Wilsmann-Theis D, Wohlrab J, Simon JC. [Treatment of psoriasis with secukinumab : Practical guidance]. Hautarzt 2021; 72:984-991. [PMID: 34417630 PMCID: PMC8378296 DOI: 10.1007/s00105-021-04871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
Hintergrund Die mittelschwere bis schwere Psoriasis vulgaris kann wirksam mit immunmodulierenden Biologika wie dem Interleukin-17A-Inhibitor Secukinumab behandelt werden. In der Praxis stellt sich jedoch oft die Frage nach dem Vorgehen in besonderen Situationen, beispielsweise bei Infektionen, Komorbidität, Schwangerschaft oder operativen Eingriffen. Ziel der Arbeit In diesem Konsensdokument deutscher Psoriasisexperten sollen in Ergänzung zu den aktuellen Leitlinien häufige Fragen aus dem Therapiealltag zur Behandlung der Psoriasis mit Secukinumab beantwortet werden. Methoden In einem virtuellen Expertentreffen im Mai 2020 wurden auf Grundlage von Erfahrungen der Teilnehmer und aktueller Literatur praxisrelevante Aspekte der Behandlung der Psoriasis erörtert. Darauf basierend wurde ein Konsensdokument verfasst. Ergebnisse Die vorliegende Arbeit bietet praktische Hinweise zur Anamnese einschließlich der Erfassung von Vortherapien, Schweregrad der Psoriasis und Begleiterkrankungen vor Beginn einer Therapie mit Secukinumab. Ferner wird auf das Vorgehen bei Impfungen, Infektionen, operativen Eingriffen, Sondermanifestationen der Psoriasis und Komorbiditäten einschließlich vorbestehenden Autoimmunerkrankungen und Tumorerkrankungen unter Therapie mit Secukinumab eingegangen. Auch Fragen zur Familienplanung und zu gesundheitspolitischen Regularien werden diskutiert. Diskussion Die in diesem Konsensdokument zusammengefassten unterstützenden Empfehlungen zur Behandlung der Psoriasis mit Secukinumab sollen dazu beitragen, für die Patienten eine optimale Therapie zu erreichen und ihre Lebensqualität zu verbessern.
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Affiliation(s)
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Frank Behrens
- Rheumatologie, Medizinische Klinik 2, Universitätsklinikum Goethe-Universität, Frankfurt am Main, Deutschland
| | - Sascha Gerdes
- Psoriasis-Zentrum, Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Deutschland
| | - Ralph von Kiedrowski
- Dermatologische Spezialpraxis für chronisch-entzündliche System-Dermatosen, Dermato-Onkologie und Allergologie, Selters (Westerwald), Deutschland
| | - Knut Schäkel
- Hautklinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Michael Sticherling
- Hautklinik und Psoriasiszentrum, Universitätsklinikum Erlangen, Deutsches Zentrum Immuntherapie, Erlangen, Deutschland
| | - Dagmar Wilsmann-Theis
- Klinik und Poliklinik für Dermatologie und Allergologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Johannes Wohlrab
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Jan-Christoph Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
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Kirsten N, Frings V, Nikolakis GD, Presser D, Goebeler M, Zouboulis CC, Augustin M. [Epidemiology, patient quality of life, and treatment costs of hidradenitis suppurativa/acne inversa]. Hautarzt 2021; 72:651-657. [PMID: 34223939 DOI: 10.1007/s00105-021-04851-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2021] [Indexed: 12/14/2022]
Abstract
Hidradenitis suppurativa/acne inversa (HS) is associated with numerous and relevant restrictions on the quality of life for those affected and their relatives. The exact prevalence of HS varies significantly across studies, but it is likely to be higher than suggested in previous publications. HS care is associated with high costs for the healthcare system and for those affected. The introduction of biologic therapy has led to additional costs, but also to considerable additional benefits in terms of care. In view of the complexity of diagnostics and therapy, there is a particular need for optimized care concepts in order to reduce the burden on those affected, their relatives and the healthcare system.
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Affiliation(s)
- N Kirsten
- Institut für Versorgungforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Gebäude West 38 (W38), Martinistr. 52, 20246, Hamburg, Deutschland. .,Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.
| | - V Frings
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - G D Nikolakis
- Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - D Presser
- Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - M Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - C C Zouboulis
- Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland.,Hochschulklinik für Dermatologie, Venerologie und Allergologie, Immunologisches Zentrum, Städtisches Klinikum Dessau, Medizinische Hochschule Brandenburg Theodor Fontane und Fakultät für Gesundheitswissenschaften Brandenburg, Dessau, Deutschland
| | - M Augustin
- Institut für Versorgungforschung in der Dermatologie und bei Pflegeberufen, Universitätsklinikum Hamburg-Eppendorf, Gebäude West 38 (W38), Martinistr. 52, 20246, Hamburg, Deutschland.,Hidradenitis Suppurativa Foundation e. V., Dessau, Deutschland
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Abstract
Systemic treatment together with radical surgical excision is the most important treatment option for all severity grades of hidradenitis suppurativa. Tetracycline in mild-to-moderate forms and clindamycin in combination with rifampicin in moderate-to-severe forms are guideline-compliant first-line therapy with a good clinical response. Other antibiotics such as ertepenem or multiple combinations are recommended as last-line therapy due to a lack of data. Success rate with dapsone and retinoids, on the other hand, are insufficient-only acitretin can be recommended on the basis of the available studies, but with limited success. With the TNF-alpha blocker adalimumab, an effective and safe long-term therapy is available-further biologics are in clinical trials and could significantly expand the treatment portfolio in the future.
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Affiliation(s)
- A Pinter
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - U Mrowietz
- Zentrum für entzündliche Hauterkrankungen, Klinik für Dermatologie, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - T Volz
- Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
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Eubank PLC, Abreu LG, Violante IP, Volpato LER. Medicinal plants used for the treatment of mucositis induced by oncotherapy: a systematic review. Support Care Cancer 2021. [PMID: 33988743 DOI: 10.1007/s00520-021-06247-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE This systematic review aimed to identify effective medicinal plants for the treatment of mucositis induced by oncotherapy. METHODS The clinical question was the following: "Which medicinal plants are effective in the treatment of oral mucositis induced by cancer treatment?" (PubMed, Medline, Web of Science, Scopus, Lilacs, and SciELO). The keywords were the following: phytotherapy OR "herbal drug" OR "plant extract" OR plant OR "medicinal plant" OR pharmacognosy OR ethnobotany OR ethnomedicine OR ethnopharmacology OR "flower essences" OR "natural product" AND mucositis OR mucositides OR stomatitis OR stomatitides OR "oral ulcer" AND chemotherapy OR radiotherapy OR immunotherapy OR cancer OR neoplasm OR neoplasm OR tumor OR tumor. The inclusion criteria for the selection of articles were the type of study design (clinical trials) and the studied population (cancer patients presenting lesions of oral mucositis having undergone treatment with medicinal plants). RESULTS After evaluation of the works, 24 of 893 articles were selected. Matricaria chamomilla (chamomilla) presented promising results, such as a reduction in severity and lesion incidence with improved pain symptomatology. The plant extracts Isatis indigótica, Olea europaea, Calendula officinalis, A. digitatae, and M. sylvestris improved the lesions. Mucotrol™ and QRLYD herbal products improved the degree of severity of the lesions, while SAMITAL® and MUCOSYTE allowed for greater pain control. CONCLUSION The complementary treatment of oral mucositis in cancer patients, with analgesic and anti-inflammatory actions with lower side effects, is an alternative for healthcare professionals.
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Mosegui GBG, Antõnanzas F, de Mello Vianna CM, Rojas P. Drug prices in Latin American countries: the case of rheumatoid arthritis Biosimilars. Adv Rheumatol 2021; 61:14. [PMID: 33632333 DOI: 10.1186/s42358-021-00172-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this paper is to analyze the prices of biological drugs in the treatment of Rheumatoid Arthritis (RA) in three Latin American countries (Brazil, Colombia and Mexico), as well as in Spain and the United States of America (US), from the point of market entry of biosimilars. METHODS We analyzed products authorized for commercialization in the last 20 years, in Brazil, Colombia, and Mexico, comparing them to the United States of America (USA) and Spain. For this analysis, we sought the prices and registries of drugs marketed between 1999 and October 1, 2019, in the regulatory agencies' databases. The pricing between countries was based on purchasing power parity (PPP). RESULTS The US authorized the commercialization of 13 distinct biologicals and four biosimilars in the period. Spain and Brazil marketed 14 biopharmaceuticals for RA, ten original, four biosimilars. Colombia and Mexico have authorized three biosimilars in addition to the ten biological ones. For biological drug prices, the US is the most expensive country. Spain's price behavior seems intermediate when compared to the three LA countries. Brazil has the highest LA prices, followed by Mexico and Colombia, which has the lowest prices. Spain has the lowest values in PPP, compared to LA countries, while the US has the highest prices. CONCLUSION The economic effort that LA countries make to access these medicines is much higher than the US and Spain. The use of the PPP ensured a better understanding of the actual access to these inputs in the countries analyzed.
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Affiliation(s)
- Gabriela Bittencourt Gonzalez Mosegui
- Department of Health and Society, Community Health Institute, Fluminense Federal University, Rua: Marquês do Paraná, 303, 3° floor, annex building, Niterói, RJ, CEP: 24033-900, Brazil.
| | - Fernando Antõnanzas
- Department of Economy and Company, Economy Faculty, University of La Rioja, Calle la Cigüeña, 60, 26006, Logroño, La Rioja, Spain
| | - Cid Manso de Mello Vianna
- Department of Health Policy, Planning and Management, Health Medicine Institute, Rio de Janeiro Estadual University, Rua São Francisco Xavier 524 - Maracanã, Bloco D, 7° floor, Rio de Janeiro, RJ, 20550-013, Brazil
| | - Paula Rojas
- Department of Economy and Company, Economy Faculty, University of La Rioja, Calle la Cigüeña, 60, 26006, Logroño, La Rioja, Spain
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Oh JH, Ham SP, Park HJ. Disseminated Tuberculosis in a Psoriasis Patient under Adalimumab Treatment despite the Chemoprophylaxis of Latent Tuberculosis: A Case Report. Ann Dermatol 2020; 33:77-81. [PMID: 33911816 PMCID: PMC7875218 DOI: 10.5021/ad.2021.33.1.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/18/2019] [Accepted: 12/11/2019] [Indexed: 11/08/2022] Open
Abstract
Recently, biologic therapy has become a major advance in the management of moderate-to-severe psoriasis. Although the overall safety profile of biologics is favorable, primary infection or reactivation of latent tuberculosis (TB) is the major concern in the setting of tumor necrosis factor-alpha inhibitor therapy. Therefore, the treatment of latent tuberculosis infection (LTBI) before starting biologics is mandatory to prevent the reactivation of LTBI. A 27-year-old female was treated with adalimumab due to psoriasis. As latent TB was detected by the interferon-γ release assay, we started isoniazid treatment (300 mg/day) 3 weeks before starting adalimumab and maintained this for 6 months. Although the patient's psoriatic skin lesions improved, after 45 weeks of adalimumab therapy, she visited the emergency department because of fever and back pain for 2 weeks. Abdominopelvic computed tomography (CT) and chest CT revealed multiple nodular lesions on both lungs, peritoneal wall, mesentery, and spleen, along with ascites. In the ascitic fluid, adenosine deaminase was increased to 96.4 U/L, and Mycobacterium tuberculosis grew in an acid-fast bacilli culture. The patient was diagnosed with disseminated TB and treated with conventional TB medication with discontinuation of adalimumab. Five months after the completion of TB treatment, the ustekinumab, an interleukin (IL)-12/IL-23 inhibitor, was administered. Until now, her skin lesions are under excellent control without reactivation of TB for 9 months after starting ustekinumab.
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Affiliation(s)
- Jae Hong Oh
- Department of Dermatology, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Seung Pil Ham
- Department of Dermatology, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Hai-Jin Park
- Department of Dermatology, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
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45
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Vasconcelos LB, Silva MT, Galvao TF. Reduction of biologics in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatol Int 2020; 40:1949-59. [PMID: 32710197 DOI: 10.1007/s00296-020-04651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
The effects of dose reduction or spacing of all types of biologics in rheumatoid arthritis has not been consistently assessed in systematic reviews. We aimed to assess the effects of biologics reduction compared with dose maintenance in patients with rheumatoid arthritis in low disease activity or remission. We performed a systematic review with meta-analysis according to a previously registered protocol (PROSPERO registration: CRD42017069080); and searched MEDLINE, Embase, Scopus, Cochrane Library and trial registers up to July, 2020. Two researchers selected, extracted and assessed the risk of bias of controlled trials that randomized patients to reduction/spacing or dose maintenance of biologics. Low disease activity, disability and other clinically important outcomes were summarized in random effect meta-analyses. We rated the certainty of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation approach. We included ten studies (n = 1331 patients), which assessed reduction or spacing of abatacept, adalimumab, certolizumab pegol, etanercept, or tocilizumab. Risk of bias was high in over half of trials, mainly due to lack of blinding. No statistically significant difference was found in low disease activity (RR = 0.90; 95% CI 0.78-1.04; I2 = 60%, very low certainty), and other outcomes. Subgroup analysis of blinded studies led to homogeneous results, which remained heterogeneous in open-label studies. Reduction or spacing biologics did not affect disease activity and other important outcome. Changes in the doses regimen should consider patient preferences, considering the low certainty of evidence.
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46
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Takeuchi T, Tanaka Y, Erdman J, Kaneko Y, Saito M, Higashitani C, Smulders R, Lademacher C. ASP5094, a humanized monoclonal antibody against integrin alpha-9, did not show efficacy in patients with rheumatoid arthritis refractory to methotrexate: results from a phase 2a, randomized, double-blind, placebo-controlled trial. Arthritis Res Ther 2020; 22:252. [PMID: 33087159 PMCID: PMC7579887 DOI: 10.1186/s13075-020-02336-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 10/02/2020] [Indexed: 01/16/2023] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic, debilitating autoimmune condition characterized by joint synovial inflammation. Current treatments include methotrexate (MTX), biologic agents, and Janus kinase (JAK) inhibitors. However, these agents are not efficacious in all patients and there are concerns regarding side effects and risk of infection as these treatments target immune-related pathways. Overexpression and activation of integrin alpha-9 (α9) on fibroblast-like synoviocytes are associated with RA disease onset and exacerbation. The humanized immunoglobulin G1 monoclonal antibody ASP5094 was designed to inhibit human α9 and is currently under investigation for the treatment of RA. Methods This phase 2a, multicenter, randomized, placebo-controlled, double-blind, parallel-group study (NCT03257852) evaluated the efficacy, safety, and biological activity of intravenous ASP5094 10 mg/kg in patients with moderate to severe RA that was refractory to MTX. Patients received ASP5094 or placebo every 4 weeks for a total of three administrations. Both treatment groups used concomitant MTX. The primary efficacy endpoint was the proportion of patients who responded per American College of Rheumatology 50% improvement using C-reactive protein (ACR50-CRP) after 12 weeks of treatment. Biological activity of ASP5094 was assessed via pharmacokinetics and pharmacodynamics of known downstream effectors of α9. Safety was also assessed. Results Sixty-six patients were enrolled and randomized to placebo (n = 33) or ASP5094 (n = 33). In the primary efficacy analysis, ACR50-CRP response rates were 6.3% and 18.2% at week 12 in the ASP5094 and placebo groups, respectively; a difference of − 11.9, which was not significant (2-sided P value = 0.258). No trends in ACR50 response rates were observed in subgroups based on demographics or baseline disease characteristics, and no significant differences between placebo and ASP5094 were identified in secondary efficacy or pharmacodynamic endpoints, despite achievement of target serum concentrations of ASP5094. Most treatment-emergent adverse events were mild to moderate in severity, and ASP5094 was considered safe and well tolerated overall. Conclusion Although no notable safety signals were observed in this study, ASP5094 was not efficacious in patients with moderate to severe RA with an inadequate response to MTX. Trial registration ClinicalTrials.gov, NCT03257852. Registered on 22 Aug. 2017
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Affiliation(s)
- Tsutomu Takeuchi
- Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, 160-8582, Japan.
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Jay Erdman
- Astellas Pharma Global Development, Northbrook, IL, USA
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Garcia Salinas RN, Lázaro MA, Scarafia S, Cusa A, Martire MV, Capozzi N, Casalla L, Zárate L, De la Vega M, Correa M, Casado GC, Papasidero S, Perez S, Rillo OL, Alvarez D, Benegas M, Girard Bosch MP, Kirmayr K, Gomez R. Performance of the RABBIT infection risk score in an Argentinian rheumatoid arthritis cohort. Clin Rheumatol 2021; 40:513-9. [PMID: 32986234 DOI: 10.1007/s10067-020-05425-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Patients with rheumatic autoimmune diseases have a higher risk of infections compared with age-and sex-matched controls. In Latin America, there are no validated tools to assess the risk of serious infection. The objectives were to estimate the incidence of serious infections in a cohort of rheumatoid arthritis (RA) patients followed for 12 months and to validate the RABBIT risk score for serious infections. Patients with RA were included and followed for 12 months. Baseline sociodemographic data, comorbidities, RA characteristics, and vaccination status were recorded. The baseline RABBIT risk score was calculated. Serious infections were documented, describing site and time since enrollment. Six hundred five patients were included (13 centers). The incidence of serious infection was 5% (95% CI 3-7). The most frequent sites were respiratory and urinary (90%). Performance of RABBIT risk score: patients with no infection during follow-up had a median score of 1.2 (IQR 0.8-2.1) and patients with infection 5.1 (IQR 2.15-12.6) p 0.00001. ROC curve analysis: AUC 0.86 (95% CI 0.8-0.94), best cut-off 2.85 (sensibility 75%, specificity 85%). The incidence of serious infections was 5% during the follow-up. The RABBIT score performed excellently in our patients. Key Points • The RABBIT risk score for serious infections showed an excellent performance in a population different (Latin America) from the original one included in the German registry. • This may assist rheumatologists in selecting drugs for patients according to the individual risk of infection, in a fast and simple way.
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Abstract
Severe asthma patients comprise about 3% to 13% of all asthma patients, but they have higher hospital utilization rates and higher medical costs than those of nonsevere asthma patients. Treatment methods for severe asthma patients are still lacking; however, the recent development of biologics is expected to have a positive effect. The biological therapies developed so far are mainly aimed at treating asthma patients with type 2 inflammation. These biologics have been found to reduce symptoms of asthma, improve lung function, reduce the use of oral corticosteroids, and improve quality of life of patients. This article reviews the mechanism of action and indications for approved biologics and discusses what should be considered when choosing biologics.
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Affiliation(s)
- Hyun Jung Jin
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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49
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Pan X, Dong L, Yang L, Chen D, Peng C. Potential drugs for the treatment of the novel coronavirus pneumonia (COVID-19) in China. Virus Res 2020; 286:198057. [PMID: 32531236 PMCID: PMC7282797 DOI: 10.1016/j.virusres.2020.198057] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/15/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
The fight against the novel coronavirus pneumonia (namely COVID-19) that seriously harms human health is a common task for all mankind. Currently, development of drugs against the novel coronavirus (namely SARS-CoV-2) is quite urgent. Chinese medical workers and scientific researchers have found some drugs to play potential therapeutic effects on COVID-19 at the cellular level or in preliminary clinical trials. However, more fundamental studies and large sample clinical trials need to be done to ensure the efficacy and safety of these drugs. The adoption of these drugs without further testing must be careful. The relevant articles, news, and government reports published on the official and Preprint websites, PubMed and China National Knowledge Infrastructure (CNKI) databases from December 2019 to April 2020 were searched and manually filtered. The general pharmacological characteristics, indications, adverse reactions, general usage, and especially current status of the treatment of COVID-19 of those potentially effective drugs, including chemical drugs, traditional Chinese medicines (TCMs), and biological products in China were summarized in this review to guide reasonable medication and the development of specific drugs for the treatment of COVID-19.
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Affiliation(s)
- Xiaoqi Pan
- School of Public Health and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Lan Dong
- The Third People's Hospital of Chengdu, Chengdu, 610031, China
| | - Lian Yang
- School of Public Health and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Dayi Chen
- School of Public Health and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Cheng Peng
- School of Public Health and School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China.
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50
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Grieshaber-Bouyer R, Lorenz HM. [Biosimilars: opportunities and risks]. Internist (Berl) 2020; 61:522-529. [PMID: 32333085 DOI: 10.1007/s00108-020-00784-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Biologic therapies are a key component of modern medicine, especially in the treatment of chronic conditions and in particular immune-mediated diseases. Biosimilars are molecularly highly similar variants of biologic therapies approved after patent expiration of the original product. OBJECTIVES To provide an overview of the emerging role of biosimilars and present data with respect to efficacy and safety. CURRENT DATA Since the approval of human insulin as the first biologic therapy, over 150 biologic therapeutics have been approved in the European Union (EU). Due to the high cost of development and production, biologic therapies place a heavy burden on healthcare systems and, at costs totaling 13.8 billion Euros annually, comprise one third of the annual drug expenditure in Germany. Biosimilars are highly similar versions of already approved biologic therapies that do not have clinically relevant differences with respect to efficacy, safety and immunogenicity, as far as can currently be ascertained. Through competition with the original product, biosimilars have been able to drive down prices and relieve the healthcare system without changing overall efficacy. The potential savings through biosimilars are estimated to be 500 million Euros in Germany alone. Currently, over 50 biosimilars of 16 different biologic therapies are approved in the EU. CONCLUSIONS Biosimilars are safe and economical alternatives to biooriginal drugs that can boost access to modern, high-cost therapies and relieve healthcare systems.
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Affiliation(s)
- R Grieshaber-Bouyer
- Medizinische Klinik V, Klinik für Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland.
| | - H-M Lorenz
- Medizinische Klinik V, Klinik für Hämatologie, Onkologie und Rheumatologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland
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